Patient: Description of the condition (time of onset, main symptoms, hospital visits, etc.): Patient, 37 years old. Frequent constipation, once a day, becomes a lump and is very difficult. I had a hemorrhoid surgery in the first month of last year, and the condition became worse after that. There was almost no urge to defecate, and the stimulation range increased. Laxatives are often taken to relieve symptoms. Taking the fruit guide tablet at the earliest time can relieve it, but the effect becomes worse and worse. Later, I switched to senna, and the initial effect was okay, but the effect was not obvious afterwards. Recently, the effect of taking Changqing Tea is not very good. Can I see you for medical treatment? Is there any good treatment? I heard that surgery can be done, is my condition an indication for surgery?
Liu Baolin, Department of Surgery, Shengjing Hospital Affiliated to China Medical University: First, adjust the diet, eat more fruits, vegetables, honey, water, etc., eat laxative foods such as wheat bran, and then use drugs to assist the conditioning, such as lactulose and hemp Runchang pills alternately orally, if If you have long-term use of laxatives and the effect is not good, you need to complete the colon transmission function test, barium enema, defecography, colonoscopy, and determine the cause and severity of constipation. If the medication is ineffective, the patient and When the family members have a strong desire for surgery, surgical treatment, subtotal colectomy + modified Duhamel surgery, can solve the mixed refractory constipation of colonic transit dysfunction and pelvic dysfunction at one time. Surgery is relatively risky, with intestinal adhesions, intestinal obstruction, or even intestinal fistula risks, and the cost of surgery is also high, so you need to choose carefully. At present, laparoscopic-assisted minimally invasive surgery is the first choice. It has less trauma, quick postoperative recovery, low complication rate, can solve constipation, and has a low recurrence rate and a low incidence of intractable diarrhea. can choose. Be cautious!
Patient: Thank you very much for Dr. Liu's answer! I will follow your guidance. Carry out dietary conditioning and drug-assisted treatment. Before, we went to the municipal hospital for consultation and said that it could be treated with surgery. We also understand the risks and complications of some operations. Who is willing to get the knife if not a last resort! It really doesn't work, let's consider surgery again! Thank you again for your reply in your busy schedule, thank you! I wish you success in your work!
Liu Baolin, Department of Surgery, Shengjing Hospital, China Medical University: This operation is performed when the patient's medication is completely ineffective. Generally, it is very accurate to solve constipation, but there are still risks in the operation book, such as intestinal obstruction, intestinal fistula, etc. Once it occurs, the risk is very high and the cost is high. We generally use laparoscopic assisted surgery. The abdominal incision is small and the trauma is not large. The treatment cost is about 60,000 yuan. This total colectomy and modified Duhamel operation is currently one of the most reasonable surgical procedures for intractable constipation at home and abroad. It is a one-time solution for colonic transmission disorders and pelvic dysfunction. The chance of constipation recurrence is small, and the incidence of intractable diarrhea is low. The patient is required to check before the operation: colonic transit function test, defecography, barium enema, colonoscopy, etc. If there are no other special problems in the intestines (such as tumors, etc.) and the patient and family members have a strong willingness to operate, the operation can be performed.